American Journal of Public Health

Kirsten K. Davison, Selma Gicevic, Alyssa Aftosmes-Tobio, Claudia Ganter, Christine L. Simon, Sami Newlan, and Jennifer A. Manganello*

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ABSTRACT
Background. Childhood obesity is one of the leading causes of compromised health in children. Because parents are fundamental stakeholders in childhood obesity prevention, it is critical that research informing parenting interventions is based on the best possible evidence with diverse family caregivers. The involvement of fathers in caregiving has increased substantially over the past 30 years. Yet research on parenting and child health has not kept pace with this demographic shift. In child and adolescent psychopathology, few studies include fathers as research participants and few present results for fathers separate from those for mothers. Although it has been suggested that a similar pattern exists in research on parenting and childhood obesity, no study has tested this hypothesis.
Objectives. We conducted a systematic review and quantitative content analysis of observational studies on parenting and childhood obesity to (1) document the inclusion of fathers, relative to mothers, as research participants and (2) examine characteristics of studies that did and did not include fathers. This study builds on a larger systematic review on parenting and childhood obesity, and presents new data on the number and gender of parent research participants.
Search methods. We searched title, abstract, and Medical Subject Headings term fields in 5 research databases (PubMed, EMBASE, Academic Search Premier, PsycINFO, and CINAHL) using search terms that combined parents or parenting (e.g., mother, father, caregiver, parenting style, food parenting) and obesity (e.g., obesity, body weight, overweight) or obesity-related lifestyle behaviors (e.g., diet, snacking, physical activity, outdoor play, exercise, media use).
Selection criteria. We identified and screened studies by using methods outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Eligible studies included observational studies that were published between January 2009 and December 2015, examined links between parenting and childhood obesity, included parents or caregivers as research participants, and were written in English. We excluded interventions, nonhuman studies, dissertations, conference abstracts, and studies on youths with specific medical conditions. Our search protocol yielded 5557 unique studies and a final sample of 667 studies following the application of eligibility criteria.
Data collection and analysis. We used quantitative content analysis to code eligible studies (n = 667). For each study, 4 coders were trained to code characteristics of the study (e.g., publication year, geographic region, journal, study focus) and parent research participants (e.g., parent gender, demographic background, biological relationship with child, and residential status) by using a standardized codebook. We established intercoder reliability before coding the full sample of studies (mean Krippendorf’s alpha = .79; average percentage agreement = 94%).
Main results. Of the studies, 1% included only fathers. By contrast, 36% included only mothers. Although slightly more than 50% of studies (n = 347) included at least 1 father, only 57 studies reported results for fathers separate from those for mothers. When we combined them with studies including only fathers, 10% of studies overall reported results for fathers. Samples sizes of fathers were small compared with mothers. Of studies with fathers, 59% included 50 or fewer fathers, whereas 22% of studies with mothers included 50 or fewer mothers. The mean sample size for fathers across all eligible studies was 139, compared with 672 for mothers. Overall, fathers represented 17% of parent participants across all eligible studies.
Conclusions. This study unequivocally demonstrates that fathers are underrepresented in recent observational research on parenting and childhood obesity.

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* Denotes CSDA Associates and Staff